Delivery mechanism for implantable stent

ABSTRACT

A delivery mechanism for an implantable stent which provides a high mechanical advantage to the surgeon and convenient operation so as to facilitate smooth withdrawal of an outer catheter sheath following placement of the stent in the desired location within the patient&#39;s vessel. Preferred embodiments include a moving rail actuated by a V-shaped lever, a hydraulic actuator, a rack and pinion drive, and a power screw system. The delivery mechanism has a movable member that is attached to the outer catheter sheath so that actuating the mechanism results in an incremental movement of the moveable member, which in turn results in an incremental movement of the outer catheter sheath. Once the outer catheter sheath is retracted from the stent, the stent is deployed into the patient&#39;s vessel and the remaining parts of the mechanism, including an inner tube, an atraumatic tip, and a stabilizing element, are easily removed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.60/102,498, filed Sep. 30, 1998.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to implantable medical devices. Moreparticularly, the present invention relates to mechanisms for implantinga self-expanding stent graft which is used to sustain a weakened bodyvessel.

2. Description of Related Art

Various diseases of blood vessels or hollow organs cause a stenosis orcomplete occlusion of their lumen, which results in a decrease orcomplete loss of their functional attributes. Various implantableprosthetic devices for sustaining a blood vessel or hollow organ lumentypically have a tubular-shaped frame body which is introduced into thevessel or hollow organ and fixed in the necessary location to sustainthe lumen.

A commonly used implant is a tubular-shaped wire frame known as a stentgraft. In one type of stent graft, the wire frame is made ofself-expanding nickel-titanium (nitinol) shape memory alloy which islaser cut and encapsulated within two layers of expandedpolytetrafluoroethylene (ePTFE). The layers of ePTFE are processed suchthat the material forms a monolithic structure, fully enclosing themetallic stent where the cover is present. The encapsulation is intendedto prevent restenosis of the vessel. The inner blood contacting lumen ofthe stent graft is impregnated with carbon. Typically, one or both endsof the stent graft is flared and free of encapsulation in order tofacilitate anchoring within the vessel. The nitinol alloy is placed intothe body during surgery at room temperature. As it increases to bodytemperature, it expands to its desired size. Balloon angioplasty may bedone after implantation of the stent to set its final shape.

In order to introduce the stent into the body vessel, it is placedwithin a tubular sheath catheter. When the device is positioned at thedesired location, it is released from the tubular sheath and permittedto expand radially against the wall of the vessel. When the outer sheathis removed, the physician must be careful to avoid migration of thestent away from the desired location. Typical prior art devices employ asimple ratchet mechanism in conjunction with the outer sheath and aninner lumen. The inner lumen is maintained stationary to fix the stentin position and the outer lumen is drawn away from the stent by means ofthe ratchet mechanism actuated by a spring loaded trigger. Each pull onthe trigger causes the outer sheath to retract by an amountcorresponding to the stroke of the trigger. An anchor to which the outersheath is attached includes a tooth which engages with each tooth of theratchet mechanism. This mechanism has drawbacks in that it is awkward tooperate and difficult to maintain steady so that the stent graft doesnot migrate away from its desired position during sheath retraction.

SUMMARY OF THE INVENTION

The present invention is directed to a stent delivery mechanism which isboth easy to operate and facilitates extremely precise stentpositioning. Several different configurations are described. In thefirst embodiment, a simple V-shaped grip aligned generallylongitudinally with the catheter to be deployed is utilized. Amechanical advantage gear mechanism is employed, which operates inconjunction with a ratchet to smoothly retract a sheath hub to which theouter sheath of the catheter is attached. The mechanism is easy to graspand actuate in any rotational configuration. The V-shaped mechanismincludes a body which contains the ratchet and a drive gear leverhandle. The lever handle interacts with a drive pinion to drive theratchet by a predetermined amount, thus retracting the sheath hub by acorresponding amount. The drive gear lever handle mechanism providesboth the mechanical advantage, which results in movement of the outersheath by a relatively small amount for a large displacement of thelever handle, and a much smoother operation than the direct ratchetoperation of the prior art device.

A second embodiment of the invention employs a hydraulic mechanism toboth provide the mechanical advantage and achieve extremely smoothretraction operation. In addition, the use of hydraulics, as opposed toother systems, creates positive positioning so that the actuator willnot cause any unexpected motion. The hydraulic system may be actuated bymeans of a drive plunger similar to the operation of a syringe, or maybe equipped with a lever handle to allow a gripping action to beemployed for actuation.

In a third embodiment, a rack and pinion drive system operated by athumb wheel is employed. The rack and pinion drive system also providesa desirable mechanical advantage and promotes smooth operation.

In a fourth embodiment, a power screw drive system is employed. Thisdrive system is actuated by a thumb driven concentric drive knob whichrotates to retract an internal power screw to which the outer sheath issecured. Again, a mechanical advantage is provided to promote smoothretraction of the outer sheath.

In order to further facilitate the stent deployment, the inner lumen ofthe delivery system may be formed of a metal spring, which is containedin its fully compressed state. The use of such a spring for the innerlumen provides significant advantages in that it is extremely flexible,enabling introduction of the catheter into the body and properpositioning of the stent, and yet is very rigid and non-compressible soas to maintain the stent in the desired position during outer sheathretraction.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be described by reference to the accompanyingdrawings, wherein:

FIG. 1 is a cross-sectional view of the end of a catheter illustrating astent to be implanted;

FIG. 2 is a cross-sectional view of a first embodiment of the stentdelivery mechanism of the present invention incorporating a moving railmechanism;

FIGS. 3-6 are cross-sectional views illustrating the retractionoperation of the moving rail system;

FIG. 7 is an exploded view of a preferred embodiment of the stentdelivery mechanism shown in FIG. 2.

FIG. 8 is a cross-sectional view of a second embodiment of the stentdelivery mechanism of the present invention incorporating a hydraulicmechanism

FIGS. 9-12 are cross-sectional views illustrating the operation of theembodiment of FIG. 7;

FIG. 13 is a cross-sectional view of a third embodiment of the stentdelivery mechanism of the present invention employing a rack and pinionthumb actuated drive system;

FIG. 14 is a view of the system of FIG. 13 along line 14—14;

FIGS. 15 and 16 are cross-sectional views illustrating the operation ofthe drive system of FIG. 13;

FIG. 17 is a cross-sectional view of a fourth embodiment of the stentdelivery mechanism of the present invention employing a power screwdrive system;

FIG. 18 is an end plan view illustrating the drive knob and collarconfiguration of the system of FIG. 17; and

FIGS. 19 and 20 are cross-sectional views illustrating the operation ofthe power screw drive system of FIG. 17.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The following description is of the best presently contemplated modes ofcarrying out the invention. The description is made for illustrating thegeneral principles of the invention and is not to be taken in a limitingsense.

FIG. 1 illustrates the distal end of a catheter 11 having a stent 16carried within it for implantation into the body of a patient. Theproximal end of the catheter 11 is connected to any of the deliverymechanisms to be described, and the catheter 11 is of sufficient lengthto reach the point of implantation of the stent 16 from the introductionpoint into the body. The catheter 11 includes an outer sheath 10, amiddle tube 12 which in the preferred embodiment is formed of acompressed spring, and a flexible (e.g., polyamide) inner tube 14. Theouter sheath 10 preferably has an ePTFE liner with a polyether blockedamide plastic (pebax) basecoat with reinforced braid, and an externallayer of pebax. A stent 16 for implantation into a patient is carriedwithin the outer sheath 10. The stent 16 includes a nitinol memory metalalloy frame 18 which is formed in a criss-cross pattern which may belaser cut. Most or all of the length of the stent is encapsulated withintwo layers of ePTFE to form a monolithic body structure 20, fullyenclosing the metallic stent 16 both internally and externally where thecover 20 is present. One or both ends of the stent 16 may be leftuncovered as illustrated at 22 and 24 to provide anchoring within thevessel where the stent 16 is to be implanted.

A radiopaque atraumatic tip 26 is secured to the end of the inner tube14 of the catheter. The atraumatic tip 26 has a rounded end and isgradually sloped to aid in the movement of the catheter through the bodyvessel. The atraumatic tip 26 is radiopaque so that its location may bemonitored by appropriate equipment during the surgical procedure. Theinner tube 14 is hollow so as to accommodate a guide wire, which iscommonly placed in the vessel prior to insertion of the catheter,although the invention may employ a solid inner section and be usedwithout a guide wire. Inner tube 14 has sufficient kink resistance toengage the vascular anatomy without binding during placement andwithdrawal of the delivery system. In addition, inner tube 14 is ofsufficient size and strength to allow saline injections without rupture.

A generally cup-shaped element 28 is provided within the catheter 11adjacent the rear end of the stent 16 and is attached to the end of thespring 12 by appropriate means, e.g., the cup element 28 may be plasticwherein the spring 12 is molded into its base, or the cup element 28 maybe stainless steel wherein the spring 12 is secured by welding or thelike. The open end of the cup element 28 serves to compress the end 24of the stent 16 in order to provide a secure interface between the stent16 and the spring 12. Alternatively, instead of a cup shape, the element28 could be formed of a simple disk having either a flat or slightlyconcave surface for contacting the end 24 of the stent 16.

In order to deploy the stent 16 inside a body vessel during a surgicalprocedure, the catheter 11 is introduced into the designated vessel viaan introducer positioned at the skin of the patient. As mentioned above,a guide wire may have previously been introduced into the vessel, inwhich case the catheter 11 is introduced by passing the tip 26 over theend of the guide wire outside of the patient and moving the catheter 11along the path within the vessel which has been established by the guidewire.

The position of the catheter 11 is tracked by monitoring the tip 26 bymeans of a fluoroscope. When the catheter 11 is at the desired locationi.e., when the stent 16 is positioned at the location where it is beimplanted, the movement of the catheter 11 is halted. The catheter 11must then be removed, leaving the stent 16 in place at the desiredlocation within the vessel. This is accomplished by initially retractingthe outer sheath 10, i.e., towards the left in FIG. 1, until it nolonger covers the stent 16. The spring 12 is maintained in a fixedposition and, in conjunction with the cup element 28, serves to maintainthe stent 16 in its desired position during the retraction of the outersheath 10. After the outer sheath 10 has been retracted such that it nolonger covers the stent 16 and the stent 16 is expanded, the tip 26 canbe pulled back through the stent 16 until the tip 26 abuts the outersheath 10. As illustrated, the diameter of the tip 26 is slightlygreater than the inner diameter of stent 16 when it is inside the outersheath 10. The stent 16 will expand as it heats up to body temperatureas a result of its memory metal characteristics. The tip 26 is thenpulled through the center of the stent 16 after the stent 16 hasexpanded following withdrawal of the sheath 10. Once the tip 26 has beenpulled back against the outer sheath 10, the catheter 11 can be removedfrom the vessel of the patient. This retraction procedure ensures thatthe tip 26 does not get caught on or embedded in any body vessel whenbeing pulled out of the patient.

As discussed above, the tube spring 12 is maintained stationary duringthe withdrawal of the outer sheath 10 and serves to keep the stent 16 inits desired location. The tube spring 12 is very well suited for thistask since it has extremely low compression in a longitudinal directiononce it is fully compressed. It is also well suited for the introductionof the catheter 11 into the body vessel, since it is extremely flexible.Alternatively, other materials, such as various plastics materials,could be employed as the middle tube 12, so long as the compression islow to maintain stent positioning and the necessary flexibility isprovided for moving through the vessel. In order to properly deploy thestent 16, the outer sheath 10 must be smoothly retracted while the tubespring 12 maintains its position. The present invention provides anumber of mechanisms intended to perform this operation with maximumease of use and minimal stent migration.

FIG. 2 illustrates a first embodiment of a delivery mechanism forimplanting the stent 16. This mechanism is generally in the form of aV-shaped lever device having a housing shell 30 from which the outersheath 10 extends. The sheath 10 is secured to a pawl/sheath hub 32. Aspring pawl 34 attached to the hub 32 engages a ratchet 36 which isintegrated into the housing shell 30. Movement of the sheath hub 32within the housing shell 30 is thus constrained to moving to the rightas shown in FIG. 2. The tube spring 12 is secured in a fixed position toa guide wire port 38. The interior of the device may be flushed by meansof a flush stop cock 40. A ratchet rail 42 is provided at the bottom ofthe housing shell 30 and is reciprocal back and forth within the shell30. The rail 42 includes ratchet teeth 44 on the upper side which engagewith the spring pawl 34 and a rack gear 46 on the bottom surface thereofwhich engages a pinion 48. The pinion 48 is rotated by means of a leverhandle 50 which includes a drive gear 52. The lever handle 50 is springbiased by means of a spring 54 to its open position. Other types ofsprings, such as a spring contained within the pivot point 56 of thelever handle could alternatively be employed.

The operation of the device of FIG. 2 will be described with referenceto FIGS. 3-6. Initially, as illustrated in FIG. 3, the handle 50 is inits open position, which forms an angle of approximately twenty-fivedegrees with the housing shell 30. When the handle is squeezed, bringingit adjacent to the housing shell as indicated by arrow 58 in FIG. 4, thedrive gear 52 rotates the pinion 48 in a clockwise direction asillustrated by arrow 60. The pinion 48 drives the rail 42 to the right,which in turn drives the sheath hub 32 to the right, thus extracting theouter sheath 10 by an incremental distance illustrated at 62. In thedescribed device, the incremental distance is approximately 1 cm.Referring to FIG. 5, when the handle 50 is released, the spring actionreturns it to the open position, thus rotating the pinion 48counterclockwise and returning the rail 42 to its leftward position. Thesheath hub 32 is maintained stationary by the ratchet 36.

The described device is intended for use with stents of approximately40-100 mm in length. In order to fully retract the outer sheath 10, thelever handle 50 must be closed and opened a number of times. FIG. 6illustrates the mechanism in which the handle 50 has been operated tomove the hub 32, and therefore the outer sheath 10, back to itscompletely rightmost position. In this position (or sooner dependingupon the length of the stent) the outer sheath 10 will be completelyaway from the stent 16, allowing the stent 16 to expand. As describedabove, once the stent 16 expands, the inner tube 14 and tip 26 arepulled back through the middle of the stent 16 until the tip 26 is tightagainst the outer sheath 10. The entire catheter 11 can then be removed,leaving the stent 16 in place at the desired location.

A preferred embodiment of the device shown in FIG. 2 is illustrated bythe exploded view in FIG. 7. In this view, a left housing assembly 31and a right housing assembly 33 can be seen. An inner catheter assembly37 is disposed between the housing assemblies 31 and 33 to support thetube spring 12 as well as the spring pawl 34. A strain relief member 51fits over the end of housing shell 30 to reduce any potential pressurecaused in the actuation of the mechanism. A safety pin 53 is insertableinto the lever handle 50 for additional protection. Upon completion ofthe deployment of the stent 16 and the retraction of outer sheath 10, aretractor sleeve 49 is pulled back slightly, releasing a retractor latch47 from its locked position on the inner catheter assembly 37. The innercatheter assembly 37, which is coupled to the inner tube 14, is pulledback away from the housing assemblies 31 and 33 in order to retract theinner tube 14 far enough so that tip 26 is snuggly against the outersheath 10. The catheter 11, including the outer sheath 10, the innertube 14 and the tip 26 can then be removed from the body. Retraction ofthe catheter 11 in this manner ensures that the tip 26 can not getcaught on anything outside of the body or inside the delivery mechanism.

The gear mechanism including the lever gear 52, pinion 48 and rack 46 isdesigned to provide a mechanical advantage of approximately 4:1. Themechanical advantage along with the rotating pinion configurationprovides very smooth and linear operation with minimal fly back duringthe return stroke. In addition, the lever handle configuration isextremely convenient, as it can be easily operated in almost anyrotational orientation. This is important due to the fact that when acatheter is introduced into the patient, it is often necessary to rotatethe catheter in order for it to most easily follow the desired paththrough the vessel to the stent location. Therefore, the finalorientation when the stent is to be deployed is variable. Theconfiguration of the V-shaped lever handle mechanism enables a simplegripping action to be applied, and is easily gripped by the surgeonregardless of its final orientation. Generally, approximately ten cycles(i.e., squeezing and releasing) of the lever handle 50 are necessary tofully remove the outer sheath 10 from the stent. The configuration ofthis embodiment enables retraction to be done in a very smooth andlinear fashion.

A second embodiment of the stent delivery mechanism is illustrated inFIG. 8. This delivery mechanism employs a hydraulic system to achieveextremely smooth operation. A housing 62 defines a reservoir chamber 64within which is carried a piston 66. The outer sheath 10 is connected tothe piston 66 to be moved therewith. A V-cup seal 68 prevents leakage ofthe hydraulic fluid carried within the housing. A piston displacementchamber 70 is defined between the piston 66 and the opening throughwhich the sheath 10 exits.

Conduits 72 and 74 are coupled to opposite ends of the piston housing62. Directional check valves 76 and 78 are contained within the conduits72 and 74, respectively. A drive plunger 80 is contained within aplunger housing 82. Hydraulic fluid, such as saline solution, isprovided through a port 84.

The operation of the hydraulic mechanism will be described withreference to FIGS. 9-12. In FIG. 9, the reservoir 64 is filled withfluid and the system is ready for operation. In FIG. 10, the plunger 80is pulled rearward and transfers saline from the reservoir 64 throughthe conduit 72 via valve 76. The valve 76 is open in this state and thevalve 78 is closed.

Referring to FIG. 11, the plunger 80 is pressed inward to open the valve78 and move fluid through the conduit 74 into the piston chamber 70,thus moving the piston 66 to the right by a fixed amount and, in turn,retracting the outer sheath 10 from the stent. In the presentembodiment, one stroke of the plunger 80 provides approximately 1 cm oftravel of the piston 66. The plunger and piston are sized to provide amechanical advantage of approximately 4:1. By repeatedly operating theplunger, the piston 66 will be drawn back to its fully deployed positionas illustrated in FIG. 12. At this point, the outer sheath 10 is fullywithdrawn from the stent 16, and the catheter 11 can be pulled out ofthe patient as described above.

Although the described embodiment employs a plunger which is manuallyoperated, a lever or trigger mechanism could be employed to actuate theplunger 80. Such mechanism would include a spring return or the like tobias the plunger to the extended position. The use of a lever mechanism(in which case the plunger orientation would be reversed and a leverhandle coupled to it) would allow grip pressure to be utilized asopposed to finger or thumb pressure.

Referring to FIGS. 13-16, a third embodiment of the invention will bedescribed. This embodiment employs a rack and pinion mechanism actuatedby means of a thumb knob. In FIG. 13, the device includes a housing 82within which is carried a rack 84, movable from left to right asillustrated in FIGS. 15 and 16. The rack 84 interacts with a rack drivegear 86 coupled to a reduction drive gear 88, which in turn is driven bya knob 90 having a gear 92. The outer sheath 10 is coupled to the rack84 to be movable therewith. FIG. 14 is a cross-sectional view of FIG. 13along line 14—14, showing a different perspective of knob 90 in relationto housing 82.

In operation, the knob 90 is rotated counterclockwise as illustrated inFIG. 15, causing the gear 92 to move in the same direction. This actioncauses the reduction drive gear 88 and the rack drive gear 86 to move ina clockwise position, which in turn causes the rack 84 to retract withinthe housing by a distance of approximately 1 cm per revolution of theknob as indicated at 94. The mechanical advantage is controlled byappropriate sizing of the gears which drive the rack 84. After asufficient number of rotations, the rack 84 will be fully retracted, asillustrated in FIG. 16 and the outer sheath 10 will be completelyremoved from the stent 16 so that the catheter 11 can be removed fromthe patient as described above.

Referring to FIGS. 17-20, a fourth embodiment of the delivery systemwill be described. In this embodiment, a power screw drive system isemployed. A drive knob 96 is carried within a collar 98 of a housing100. The drive knob 96 is fixed to a power nut 102 having a threadedinterior surface which mates with the threaded surface of a power screw104 which is slidably carried within the housing 100. The outer sheath10 is coupled to the power screw 104 to move in conjunction therewith.By rotating the drive knob 96, the power nut 102 rotates and drives thepower screw 104 to the right as shown in the FIGS. 19 and 20. FIG. 18 isan end plan view, illustrating the drive knob 96 within the collar 98.The mechanical advantage of this fourth embodiment is determined by thepitch of the power screw 104 and the size of the knob 96.

As shown in FIG. 19, a single rotation of the knob 96 achieves amovement of the power screw 104 of approximately 1 cm, as indicated at106. The high mechanical advantage provided by the configurationfacilitates smooth retraction of the outer sheath 10. After a number ofrotations of the knob 96, the power screw 104 will be fully retracted,as illustrated in FIG. 20, and the outer sheath 10 will be completelywithdrawn from the stent 16. The catheter 11 can then be removed asdescribed above.

In summary, each of the disclosed systems provides a significantmechanical advantage which facilitates smooth retraction of the outersheath 10 which covers the stent 16. This minimizes migration of thestent 10 during sheath retraction, thus ensuring that the stent 16 willremain in its desired location. In addition, various configurations areprovided which are operable in numerous orientations, thus providingconvenient and simple use during surgery.

Many alterations and modifications may be made by those having ordinaryskill in the art without departing from the spirit and scope of thepresent invention. For example, a shape memory metal stent has beenillustrated as being the type of stent that is to be delivered by thedelivery mechanism of the present invention. It should be apparent,however, that the inventive concepts described above would be equallyapplicable to other types of expandable stents. Moreover, the words usedin this specification to describe the invention and its variousembodiments are to be understood not only in the sense of their commonlydefined meanings, but to include by special definition in thisspecification structure, material or acts beyond the scope of thecommonly defined meanings. Thus, if an element can be understood in thecontext of this specification as including more than one meaning, thenits use in a claim must be understood as being generic to all possiblemeanings supported by the specification and by the word itself. Thedefinitions of the words or elements of the following claims are,therefore, defined in this specification to include not only thecombination of elements which are literally set forth, but allequivalent structure, material or acts for performing substantially thesame function in substantially the same way to obtain substantially thesame result. The described embodiments are to be considered illustrativerather than restrictive. The invention is further defined by thefollowing claims.

What is claimed is:
 1. An apparatus for introducing a stent into a bodyvessel, comprising: an elongated housing, providing a passage therein,wherein said housing further comprises a stationary ratchet on a firstside, a movable ratchet on a second side directly opposite said firstside, and a pinion engaging said movable ratchet; a movable memberdisposed within said passage; actuating means coupled to said housingfor incrementally moving said movable member in a first direction; acatheter coupled to said movable member; an inner tube extending throughsaid catheter; a tip attached to said inner tube; and a stabilizingelement extending through said catheter for maintaining the position ofthe stent during retraction of said catheter.
 2. The apparatus accordingto claim 1, wherein said movable member comprises a pawl hub, includinga first and second spring pawl, wherein said first spring pawl islocated on a first side of said pawl hub engaging said stationaryratchet, and said second spring pawl is located on a second sidedirectly opposite said first side of said pawl hub engaging said movableratchet.
 3. The apparatus according to claim 1, wherein said actuatingmeans comprises a lever handle coupled to said housing including a drivegear engaging said pinion.
 4. The apparatus according to claim 3,further comprising a spring disposed between said housing and said leverhandle, biasing said lever handle in an open position.
 5. The apparatusaccording to claim 1, further comprising a withdrawing element forproximally withdrawing said inner tube and a locking mechanism, whereinsaid withdrawing element is attached to said inner tube and said lockingmechanism is releasably coupled to said withdrawing element.
 6. Anapparatus for introducing a stent into a body vessel, comprising: anelongated housing, providing a passage therein; a plunger chambercoupled to said housing; an inlet conduit providing a path for fluidfrom said plunger chamber to said housing, including a directional checkvalve; an outlet conduit providing a path for fluid from said housing tosaid plunger chamber, including a directional check valve; and a fluidport for inserting fluid into said housing; a movable member disposedwithin said passage; actuating means coupled to said housing forincrementally moving said movable member in a first direction; acatheter coupled to said movable member; an inner tube extending throughsaid catheter; a tip attached to said inner tube; and a stabilizingelement extending through said catheter for maintaining the position ofthe stent during retraction of said catheter.
 7. The apparatus accordingto claim 6, wherein said movable member comprises a piston.
 8. Theapparatus according to claim 6, wherein said actuating means comprises aplunger disposed within said plunger chamber for moving fluids to andfrom said housing.
 9. An apparatus for introducing a stent into a bodyvessel, comprising: an elongated housing, providing a passage therein; amovable member disposed within said passage; a rack drive gear coupledto a reduction drive gear, wherein said rack drive gear engages saidmovable member; actuating means coupled to said housing forincrementally moving said movable member in a first direction; acatheter coupled to said movable member; an inner tube extending throughsaid catheter; a tip attached to said inner tube; and a stabilizingelement extending through said catheter for maintaining the position ofthe stent during retraction of said catheter.
 10. The apparatusaccording to claim 9, wherein said movable member comprises a rackelement.
 11. The apparatus according to claim 9, wherein said actuatingmeans comprises a knob coupled to a knob gear, wherein said knob gearengages said reduction drive gear.
 12. An apparatus for introducing astent into a body vessel, comprising: an elongated housing, providing apassage therein; a movable member disposed within said passage,comprising a power screw that has a threaded exterior surface; actuatingmeans coupled to said housing for incrementally moving said movablemember in a first direction; a catheter coupled to said movable member;an inner tube extending through said catheter; a tip attached to saidinner tube; said a stabilizing element extending through said catheterfor maintaining the position of the stent during retraction of saidcatheter.
 13. The apparatus according to claim 12, wherein saidactuating means comprises a drive knob coupled to a power nut, whereinsaid power nut has a threaded interior surface that mates with thethreaded exterior surface of said power screw.
 14. An apparatus forintroducing a stent into a body vessel, comprising: an elongatedhousing, providing a passage therein, wherein said housing furthercomprises a stationary ratchet on a first side, a movable ratchet on asecond side directly opposite said first side, and a pinion engagingsaid movable ratchet; a pawl hub disposed within said passage, includinga first and second spring pawl, wherein said first spring pawl islocated on a first side of said pawl hub engaging said stationaryratchet, and said second spring pawl is located on a second sidedirectly opposite said first side of said pawl hub engaging said movableratchet; a lever handle coupled to said housing, including a drive gearengaging said pinion; a catheter coupled to said pawl hub, an inner tubeextending through said catheter; a tip attached to said inner tube; anda stabilizing element extending through said catheter for maintainingthe position of the stent during retraction of said catheter.
 15. Theapparatus according to claim 14, wherein said stabilizing elementcomprises a tube spring coupled to a holding member, wherein saidholding member grips a proximal end of the stent.
 16. The apparatusaccording to claim 15, wherein said holding member is cup-shaped. 17.The apparatus according to claim 14, further comprising a springdisposed between said housing and said lever handle, biasing said leverhandle in an open position.
 18. The apparatus according to claim 14,further comprising a withdrawing element for proximally withdrawing saidinner tube and a locking mechanism, wherein said withdrawing element isattached to said inner tube and said locking mechanism is releasablycoupled to said withdrawing element.
 19. The apparatus according toclaim 14, wherein said tip is radiopaque.
 20. An apparatus forintroducing a stent into a body vessel, comprising: an elongatedhousing, providing a passage therein including a port for insertingfluid; a piston disposed within said passage; a plunger chamber coupledto said housing; an inlet conduit providing a path for fluid from saidplunger chamber to said housing, including a directional check valve; anoutlet conduit providing a path for fluid from said housing to saidplunger chamber, including a directional check valve; a plunger disposedwithin said plunger chamber for moving fluids to and from said housing;a catheter coupled to said piston, an inner tube extending through saidcatheter; a tip attached to said inner tube; and a stabilizing elementextending through said catheter for maintaining the position of thestent during retraction of said catheter.
 21. The apparatus according toclaim 20, wherein said stabilizing element comprises a tube springcoupled to a holding member, wherein said holding member grips aproximal end of the stent.
 22. The apparatus according to claim 21,wherein said holding member is cup-shaped.
 23. The apparatus accordingto claim 20, wherein said tip is radiopaque.
 24. An apparatus forintroducing a stent into a body vessel, comprising: an elongatedhousing, providing a passage therein; a rack element disposed withinsaid passage; a reduction drive gear coupled to said housing; a rackdrive gear coupled to said reduction drive gear, wherein said rack drivegear engages said rack element; a knob including a knob gear, whereinsaid knob gear engages said reduction drive gear; a catheter coupled tosaid rack element, an inner tube extending through said catheter; a tipattached to said inner tube; and a stabilizing element extending throughsaid catheter for maintaining the position of the stent duringretraction of said catheter.
 25. The apparatus according to claim 24,wherein said stabilizing element comprises a tube spring coupled to aholding member, wherein said holding member grips a proximal end of thestent.
 26. The apparatus according to claim 25, wherein said holdingmember is cup-shaped.
 27. The apparatus according to claim 24, whereinsaid tip is radiopaque.
 28. An apparatus for introducing a stent into abody vessel, comprising: an elongated housing, providing a passagetherein; a power screw disposed within said passage, including athreaded exterior surface; a drive knob coupled to said housing; a powernut coupled to said drive knob, wherein said power nut has a threadedinterior surface that mates with the threaded exterior surface of saidpower screw; a catheter coupled to said power screw, an inner tubeextending through said catheter; a tip attached to said inner tube; anda stabilizing element extending through said catheter for maintainingthe position of the stent during retraction of said catheter.
 29. Theapparatus according to claim 28, wherein said stabilizing elementcomprises a tube spring coupled to a holding member, wherein saidholding member grips a proximal end of the stent.
 30. The apparatusaccording to claim 29, wherein said holding member is cup-shaped. 31.The apparatus according to claim 28, wherein said tip is radiopaque.